Pharmacist and Physician Collaborative Practice Model Improves Vancomycin Dosing in an Intensive Care Unit.

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Infectious Diseases

Background:

• Suboptimal initial vancomycin dosing can lead to subtherapeutic levels, potentially impacting treatment efficacy.
• Effective vancomycin dosing is crucial for managing serious infections and preventing resistance.

Purpose of the Study:

• To evaluate a pharmacist and physician collaborative practice intervention aimed at optimizing initial vancomycin dosing.
• The primary goal was to decrease subtherapeutic vancomycin troughs and increase therapeutic troughs.

Main Methods:

• A nomogram was developed using actual bodyweight and estimated glomerular filtration rate (eGFR) to guide vancomycin dosing.
• The intervention involved providers ordering vancomycin based on pharmacy recommendations derived from the nomogram and guidelines.
• The study compared pre-intervention (n=75) and post-intervention (n=108) cohorts.

Main Results:

• The intervention significantly increased the median first trough vancomycin level (13.0 to 14.8 mcg/ml, p=0.03).
• The proportion of subtherapeutic troughs (<10 mcg/ml) decreased from 32% to 13% (p=0.003).
• Therapeutic troughs (10-20 mcg/ml) increased from 50.7% to 69.4% (p=0.01), with no change in excessive levels.

Conclusions:

• A nomogram-based pharmacy collaborative practice model effectively improved initial vancomycin trough levels.
• This multidisciplinary approach significantly reduced subtherapeutic vancomycin dosing by half.